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Caring for surgical wounds

After an operation, you’ll have a surgical wound from where your surgeon made a cut into your skin. It’s important that you take good care of your wound, to lower your risk of infection and ensure it heals in the best way possible.

You’ll have a surgical wound after any type of operation that involves making a cut into your skin. This includes minor procedures carried out by GPs and other doctors, as well as those done by surgeons. For simplicity, we’ll just refer to surgeons throughout this topic.

The position and size of the cut your surgeon makes will depend on the type of operation and surgery you have. For example, if you have keyhole (laparoscopic) surgery, your surgeon will make small cuts to your skin. Your cuts will be closed with stitches, clips or skin glue to bring the skin edges together to heal.

Types of wound healing

There are two main types of wound healing: primary and secondary. This topic focuses on what’s called healing by primary intention. That is, the edges of your wound are brought together and secured with stitches, staples or glue. It’s mainly used for simpler surgical wounds. Secondary wound healing is when your wound is left to heal up from below by itself. This method is mostly used if your wound is infected, or if there would be empty space underneath your wound if the skin edges were brought together.

Details

A surgical wound is a cut made to your skin during an operation. Wound healing is a complicated process but can be divided into three main phases.

Inflammation – this happens straight away and lasts for up to six days, during which time the blood flow to your wound increases.

Proliferation – this starts after a few days and can carry on for several weeks. New blood vessels grow to bring nutrients to your wound and new tissue starts to develop.

Maturation – new cells develop to strengthen your wound and soften the scar. This phase can continue for over a year.

Skin edges usually form a seal within a day or two of an operation. This can vary from person to person and from operation to operation. Closing your wound surgically (with stitches, clips or staples) encourages your wound to heal faster. The first phase of wound healing can take around two to three weeks but some people experience delayed wound healing. This can depend on the type of wound you have and how your body responds to healing.

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The medical term for stitches is sutures. Other methods that may be used to close your surgical wound include metal clips or staples and adhesive dressings, tapes or glue. The method your surgeon uses to close the cut will depend on its location, size and how strong the closure needs to be.

Some stitches are dissolvable and you won’t need to have them removed. You’ll need to have non-dissolvable stitches and clips or staples removed by a nurse or doctor. If this is necessary, your nurse will arrange a follow-up appointment at your hospital.

Stitches, clips and staples are usually removed between three and 14 days after your treatment. This will depend on a number of factors including the area of your body where the wound is and the type of operation you had. The method and material that has been used to close your wound is another deciding factor. Your surgeon will be able to give you more information about when the stitches, clips or staples need to be removed.

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Your surgeon may use special skin glue to close your wound, especially in the case of smaller wounds. One of the advantages of skin glue is that it brings the edges of your skin together quickly – within a couple of minutes. This helps to seal the wound and form a barrier that lowers the risk of infection. This may reduce the time that it takes for your wound to heal. Although the glue is waterproof, you shouldn’t let your wound soak in water. The glue usually peels off by itself in seven to 10 days.

There are a number of things that you can do to look after your wound, lower your risk of infection and encourage healing.

Changing the dressing

Depending on where your wound is on your body, you can leave your original dressing in place for around five to seven days. Your surgeon will tell you when you should remove it.

Before you remove the dressing, wash your hands with soap and water and then carefully take off the dressing. Try not to touch the healing wound with your fingers.

Your wound may then be left without a dressing. However, you might like to continue wearing one over the area for protection and comfort, particularly if your clothes are rubbing against it. The hospital may give you a replacement dressing to use at home. Apply the dressing carefully and don't touch the inside of it. Don't use antiseptic cream under the dressing.

Taking care of your wound

Dissolvable stitches usually disappear in about one to three weeks, but it can take longer, depending on the type you have. Non-dissolvable stitches, clips and staples are usually removed after three to 14 days, depending on where they are and the type of operation you had.

You may see small pieces of the stitch material poking out of your wound. Don't be tempted to pull on these. If you have loose ends that are catching on clothing, trim them carefully with a clean pair of scissors or discuss with the nurse. Otherwise, wait until they are removed or fall out on their own. As your skin heals, it’s natural for your stitches and wound to itch – it’s part of the healing process. If the stitches cause you pain or discomfort though, contact your GP or hospital for advice.

Eating and drinking properly

Your body needs energy to heal quickly so it's important that you eat well. Vitamin C and protein are important to aid wound healing. Eat a healthy, balanced diet with plenty of variety including lean meat, fish, eggs, dairy, and fruit and vegetables. Make sure that you drink enough water because if you're dehydrated, your wound may take longer to heal.

It's useful to lose any excess weight, preferably before you have surgery. Being overweight can increase the time it takes for your wound to heal and significantly increases the risk of wound infection. If you have diabetes, it’s important to take care that your blood sugar is well controlled.

Bathing and showering

It's usually possible for you to have a bath or a shower about 48 hours after surgery. However, this will depend on the particular operation you had – ask your nurse or doctor for advice.

Some general points to remember are as follows.

If possible, have showers rather than baths so that your wound doesn't soak in water. This could soften the scar tissue and cause your wound to reopen. Only have a bath if you can keep your wound out of the water.

Remove any dressing before you have a bath or shower, unless your surgeon or nurse gives you different advice. Some dressings are waterproof and can be left in place.

You can gently wash the area surrounding your wound with mild, neutral soap. Don't use any soap, shower gel, body lotion, talcum powder or other bathing products directly over your wound though.

You can let the shower water gently splash onto your healing wound. However, don't rub the area, as this might be painful and could delay the healing process.

Dry the surrounding area carefully by patting it gently with a clean towel but allow your wound to air dry.

If you had surgery on your face, don't wear make-up over the scar until it has fully healed.

While your wound is healing, you may find applying petroleum jelly helps to stop it sticking to the dressing. Silicone gel sheets are also sometimes used to improve the appearance of certain types of scars. Your surgeon may recommend that you massage the wound after two to three weeks. This is to reduce the sensitivity of your skin as it heals and to soften scar tissue that will be forming beneath it.

Creams and ointments that contain arnica are sometimes used because they are thought by some to promote wound healing. There isn’t any scientific proof to support this though. Generally, your GP or surgeon won’t advise using herbal remedies, so do talk to him or her before using any yourself.

Once you get home, if you have any concerns about your surgical wound, contact your hospital or GP.

Most surgical wounds will heal without causing you any problems, but it’s possible that your wound may become infected after surgery. If you develop an infection, you will usually be treated with a course of antibiotics. Very occasionally you may need to have further surgery.

You're more likely to develop an infection if you:

smoke

have diabetes

are overweight or obese

have a condition that affects your immune system, such as leukaemia

are undergoing a treatment that affects your immune system, such as chemotherapy

Your doctors and nurses will do everything they can to prevent your wound from becoming infected. But it’s important that you know how to spot if you're developing an infection after you go home. If your wound becomes infected, it may:

become more painful

feel tender

look red, inflamed or swollen

leak or weep liquid, pus or blood

smell unpleasant

You may also have a high temperature.

A surgical wound infection can develop in two to three days after your surgery, but may occur up to two to three weeks after your operation. If you have any of these symptoms or if you are worried about the appearance of your wound, speak to your practice nurse or GP.

Your healthcare team are there to answer any questions you might have about your wound. The National Institute for Health and Care Excellence (NICE) has suggested a few questions you might want to ask. Some good suggestions to get you started include the following.

How likely am I to get an infection?

Do infections often occur after this type of operation?

How will I know if my wound becomes infected? What should I look for?

If my wound does become infected, what should I do?

Wound infections can usually be treated successfully with antibiotics if they are diagnosed early. See our FAQs section for more information.

I think I may have an abscess in my surgical wound. What should I do?

Answer

If you get an infection in your surgical wound, it can lead to the development of an abscess. Your body responds to infections by producing pus. If this collects under your skin, it will form an abscess. If you have an abscess, it’s likely to feel swollen and painful. You may also feel feverish. If you think you have an abscess, see your GP for a check up.

If you’re diagnosed with a wound abscess, you will need treatment. Without treatment, your abscess and infection could be at risk of getting worse. If your abscess isn’t very big or deep, it may be possible to treat it with antibiotics. However, you may need to have it drained of pus and cleaned to remove damaged or infected tissue. You may be given antibiotics to take after your abscess has been drained but this is usually only if the infection has spread.

If you have a deeper abscess, you may need to have further surgery to drain and clean it. Alternatively you may have a CT or ultrasound scan so that a drain can be inserted through a thin tube using the images to guide it.

I have heard that I may develop cellulitis – what is this?

Answer

Cellulitis is a bacterial infection of the deeper layer of your skin. It more commonly affects your face or lower legs, though it can affect any area of the skin.

Your skin usually has many bacteria living on it and these don't cause problems. However, if your skin is damaged these bacteria can enter your body and grow.

If your wound becomes infected you may notice that it becomes red, inflamed or swollen. If you have cellulitis, you may also have flu-like symptoms such as:

feeling unwell

fever or chills

lack of energy

muscle aches

If you have any of these symptoms, see your GP. He or she may prescribe you antibiotics. If your infection is severe, you may need to go into hospital for treatment.

You can help to prevent cellulitis by cleaning your wound properly and watching for symptoms of an infection. You should also try to stay healthy, before and after you have surgery. If you're unwell or if you have a condition or treatment that affects your immune system, you're more likely to get an infection.

What are 'superbugs'?

Answer

The term 'superbug' is used to describe a strain of bacteria that has become resistant to the antibiotic that would usually be used to treat it. Healthcare-acquired infections (HCAIs) are infections you can catch in hospital or as a result of healthcare treatment. These include infection with resistant strains of bacteria (sometimes called 'superbugs') as well as infections that arise as a result of treatments such as surgery. There are many bacteria that cause HCAIs, but some of the most common include:

If you become infected with a resistant bacterium, you will be treated with alternative antibiotics that are effective against these infections. However, treatment is likely to take more time. You may also be at risk of passing the infection onto others. You can help to prevent the spread of infections by washing your hands thoroughly both when you’re at home and after visiting hospitals and care homes.

Ernst E, Pittler MH. Efficacy of homeopathic arnica: a systematic review of placebo-controlled clinical trials. University of York Centre for Reviews and Dissemination. www.crd.york.ac.uk, accessed 25 February 2015

Arnica. University of Maryland Medical Center. www.umm.edu, published May 2013

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